Question

Can I use herbs or supplements with Atroiza?

8 January 2018. Related: All topics, Drug interactions.

Can I use herbal formula with Atroiza. Its ingredients are eletherococcus senticocus, ginkgo biloba, sarsaparilla, guajava, mellisa officinalis, alchemilla vulgaris, discorea villosa tincture blend: Preservative: citric acid, methyl paraben?

Answer

Answer: Simon Collins

Hi

i-Base are always cautious to say any herbal formulas are safe. This is because there are so few studies that look at drug interactions and because the contents of herbal formulas vary so much.

The efavirenz in Atroiza has the potential to interact with many drugs, herbs and supplements. This includes ginkgo biloba in your list, which might make your HIV meds less effective. See below for a detailed explanation.

Instead, we emphasise the consistent evidence from research that HIV medicines are so good that supplements are unlikely to make any difference – other than costing you money.

HIV meds (antiretrovirals) are the only proven way to reduce viral load and increase your CD4 count. There is no evidence showing that herbs or supplements have any impact.

Liver enzymes – inducing and inhibiting

An enzyme is a type of chemical that increases a process. For example, liver enzymes are one of the ways that chemicals in drugs and supplements can be cleared from your body.

There are lots of specific liver enzymes, categorised by letter and numbers. One of the main enzymes is called CYP3A4 (used by 90% of drugs), another is CYP2B6. (CYP stand for “cytochrome P450”).

The levels of these enzymes is not constant though. Sometimes drugs (or herbs or supplements) increase or decrease the levels of different enzymes. This makes things very complication.

Efavirenz is processed by both 3A4 and 2B6 (and also UGT1A1). But it also induces (ie makes more) of these enzymes. So any other drug that uses these enzymes will be cleared more quickly from the body. This means drug levels might become too low to be active.

In a similar way, if other drugs or supplements increase 3A4 or 2B6, efavirenz will be process more quickly. If the other drugs slow down (inhibit) these enzymes, efavirenz levels will be much higher. Higher levels can cause more side effects and serious toxicity.

As examples, ritonavir and grapefruit juice inhibit both these enzymes, increasing efavirenz levels. Ginkgo biloba extracts and St. John’s wort both induce these enzymes – and reduce efavirenz levels, making your HIV medicine less effective.